POS0270-HPR FLARE-OA QUESTIONNAIRE TO MEASURE FLARES IN OSTEOARTHRITIS OF THE KNEE AND HIP: ASSESSMENT OF ITS PSYCHOMETRIC PROPERTIES

Background:

Hip and knee OA is characterised by disease flares – understanding the determinants and consequences of OA flares has been hampered by lack of a standardized flare measure beyond the pain aspect. The patients point of view on the different aspect of their flares is essential.

Objectives:

The objective was to assess the psychometric properties of a new questionnaire for measuring the multidimensional aspect of flares in OA.

Methods:

Using a bilingual version of the questionnaire (33 items, response on a numeric scale, from 0 to 10), a multicentre survey (Australia, France and United States) was conducted on line with patients diagnosed with OA of the hip and/or the knee. Based on an international OMERACT/OARSI endorsed definition of the five core domains (pain, swelling, stiffness, consequences of symptoms and psychological aspects) composing a flare in OA [1], a confirmatory factorial analysis linked to the content analysis has been used to reduce the number of items and to determine the validity of the structure. The Flare-OA questionnaire (score from 0 to 100) has been tested in French and English for its internal consistency, its convergent validity with HOOS/KOOS and Mini-OAKHQOL questionnaires, and its discriminant validity.

Results:

Out of 398 patients (mean age 64 years old) who completed the questionnaire, 70.4% were female and 86.7% had knee OA. The confirmatory factorial analysis retained a model with 19 items (RMSEA =0.06; SRMR =0.04; CFI =0.96 and TLI = 0.94). The Cronbach Alpha was > 0.9 for the 5 domains and for the whole questionnaire. The correlations between the Flare-OA and the other instruments were in line with that hypothesis flare is related but different from other concepts usually measured. The discriminant validity was evidenced by a significant score difference (31.8; p<0,0001) between patients with and without flare, i.e. over twice the standard measurement error.

Conclusion:

The optimized Flare-OA questionnaire (19 items) is a reliable and valid instrument freely available from the authors for measuring the frequency and severity of flare in knee and hip OA in clinical research.

References:

[1]King LK, Epstein J, Cross M, et al. Establishing the Domains of Knee and Hip Osteoarthritis (OA) Flare: A Report from the OMERACT 2020 Inaugural Virtual Consensus Vote from the Flares in OA Working Group. (Submitted)

Disclosure of Interests:

None declared

Common mental disorders among Irish jockeys: prevalence and risk factors

OBJECTIVE

Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors.

METHODS

An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%).

RESULTS

In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs.

CONCLUSION

The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockeys.

142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction

Purpose

To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards.

Methods

The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list.

Results

The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting.

Conclusions

The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.

Determination of the half-life and the absolute photon emission intensities for the main gamma-ray energies of 124I

The National Institute of Standards and Technology (NIST) performed new standardization measurements for ¹²⁴I. As part of this work the absolute photon emission intensity for the main gamma-rays of ¹²⁴I were determined using several high-purity germanium (HPGe) detectors. In addition, the half-life for ¹²⁴I was also determined using an HPGe detector. Ionization chamber measurements were performed for additional sources, but it was not possible to obtain a precise half-life value.

Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation

Issue

Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018).

Results

The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability.

Key messages

Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.

New MPH curriculum in the United States: Report on successes and challenges

Background

In October 2016, the Council on Education for Public Health, the US accreditation agency for Master of Public Health (MPH) programs, revised its criteria. The new curricular model transitions a nearly 100-year-old knowledge-based curriculum to a competency-based curriculum tailored to today's public health needs in a global society. This presentation will highlight the new content and format of MPH curricula, including programs outside the US that have participated in US accreditation.

Objectives

CEPH has tracked implementation of the new curriculum as well as overall redesign of MPH programs. The presentation will describe strengths and challenges faced by programs implementing new curricula and will describe innovative curricular models.

Results

Data show that MPH programs are strong in epidemiological methods (99%), interpreting data (99%), and designing population-based policies or programs (93%). Programs have struggled to incorporate interprofessional practice (57%), systems thinking tools (55%), and negotiation skills (59%). Data indicate that 13% retained coursework in the traditional five core disciplines; 69% added to or adjusted the core; and 18% created a new or integrated core. Examples of each structure will be provided.

Conclusions

MPH programs in the US are experiencing a major change focused on development of competencies and skills for practice. While methodological skills remain strong, “soft” skills that are important for global public health practice are more of a challenge for faculty to integrate into the current training structure. Successful programs are incorporating innovative and cross-cutting curricula to meet these new requirements.

Key messages

MPH curricular requirements in the US have changed to focus on competencies and skills for public health practice. Critical public health leadership skills such as negotiation and interprofessional communication are lagging behind in integration into the new curriculum.

Engaging ignored stakeholders of higher education accessibility practice: analysing the experiences of an international network of practitioners and researchers

Purpose

The purpose of this paper is to examine and critique current approaches of higher education (HE) community concerning stakeholder engagement in the development of information and communications technology (ICT) related accessibility practice.

Design/methodology/approach

The approach taken to this examination is to draw on presentations, panel discussions and World Café reflections from an international symposium held in Montreal where researchers and practitioners debated two key questions as follows: have all the relevant stakeholders really been identified? Are there some stakeholders that the HE community has ignored? And what factors influence successfully distributed ownership of the accessibility mission within HE institutions?

Findings

A number of “new” internal and external stakeholders are identified and it is argued that if they are to be successfully engaged, effort needs to be invested in addressing power imbalances and developing opportunities for successful strategic silo-crossing.

Originality/value

The value of this paper is in critiquing the argument that all stakeholders in the development of accessible ICT in HE need to be involved, identifying a gap in the argument with respect to whether all relevant stakeholders have actually been engaged and offering insights into this omission might be rectified.

Quantifying Soft Tissue Artefacts and Imaging Variability in Motion Capture of the Fingers

This study assessed the accuracy of marker-based kinematic analysis of the fingers, considering soft tissue artefacts (STA) and marker imaging uncertainty. We collected CT images of the hand from healthy volunteers with fingers in full extension, mid- and full-flexion, including motion capture markers. Bones and markers were segmented and meshed. The bone meshes for each volunteer's scans were aligned using the proximal phalanx to study the proximal interphalangeal joint (PIP), and using the middle phalanx to study the distal interphalangeal joint (DIP). The angle changes between positions were extracted. The HAWK protocol was used to calculate PIP and DIP joint flexion angles in each position based on the marker centroids. Finally the marker locations were 'corrected' relative to the underlying bones, and the flexion angles recalculated. Static and dynamic marker imaging uncertainty was evaluated using a wand. A strong positive correlation was observed between marker- and CT-based joint angle changes with 0.980 and 0.892 regression slopes for PIP and DIP, respectively, and Root Mean Squared Errors below 4°. Notably for the PIP joint, correlation was worsened by STA correction. The 95% imaging uncertainty interval was < ± 1° for joints, and < ± 0.25 mm for segment lengths. In summary, the HAWK marker set's accuracy was characterised for finger joint flexion angle changes in a small group of healthy individuals and static poses, and was found to benefit from skin movements during flexion.

The effect of copper-oxide-treated soft and hard surfaces on the incidence of healthcare-associated infections: a two-phase study

BACKGROUND

Copper-oxide-impregnated linens and hard surfaces within the hospital environment have emerged as a novel technology to reduce environmental contamination and thereby potentially reduce the risk of healthcare-associated infections (HCAIs).

METHODS

This was a two-phase study. Phase 1 was a prospective, cluster-randomized, cross-over clinical trial in which one pod (eight beds) of our general ICU (GICU) utilized copper-oxide-impregnated linens whereas the other pod (eight beds) used standard hospital linens. Phase 2 was a two-year before-after study, following the relocation of three ICUs into a new ICU tower in which all the hard surfaces were treated with copper oxide (in addition to copper-impregnated linens). HCAIs were recorded using the National Healthcare Safety Network definitions.

FINDINGS

A total of 1282 patients were enrolled in phase 1. There was no difference in the rate of HCAI between the patients who received standard compared with copper oxide linen. In phase 2 there was a significant reduction in the number of infections due to Clostridioides difficile (2.4 per 1000 vs 0.7 per 1000 patient-days; incidence rate ratio: 3.3; 95% confidence interval: 1.4-8.7; P = 0.002) but no difference in the rate of central-line-associated bloodstream infections nor of catheter-associated urinary tract infections.

CONCLUSION

Copper-oxide-impregnated linens alone had no effect on the rate of HCAI. Our data suggest that copper-oxide-treated hard surfaces reduced the rate of infections due to C. difficile; however, important confounders cannot be excluded.

Determination of the internal pair production branching ratio of 90Y

The National Institute of Standards and Technology (NIST) measured the internal pair production branching ratio of ⁹⁰Y using two sources and four high purity germanium (HPGe) detectors to detect the resulting annihilation radiation. The internal pair production branching ratio determined from these measurements, (32.0 ± 1.5) × 10^-6 (k = 1), agrees within 1 standard uncertainty with the recommended value of (32.6 ± 0.7) × 10^-6 (k = 1) from the DDEP database.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress

BACKGROUND

The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women.

METHODS

A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ.

RESULTS

Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (r_s=-.390, p = .001), PN3 (r_s=-.384, p = .002) and at PP (r_s= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R² = .105), PN2 (p < .001, adjusted R² = .088) and PP (p = .003, adjusted R² = .064).

CONCLUSIONS

Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Image reconstruction in cardiovascular CT: Part 2 - Iterative reconstruction; potential and pitfalls

The use of IR in CT previously has been prohibitively complicated and time consuming, however improvements in computer processing power now make it possible on almost all CT scanners. Due to its potential to allow scanning at lower doses, IR has received a lot of attention in the medical literature and has become a successful commercial product. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality. This manuscript discusses the various vendor permutations of iterative reconstruction (IR) in detail and critically appraises the current clinical research available on the various IR techniques used in cardiovascular CT.

Abstract P3-07-06: Evidence for tumor heterogeneity and clonal evolution during invasive progression in breast cancer

Purpose: Intratumoral heterogeneity is well recognized to be an important driver of treatment resistance and metastasis. We undertook this N of three study to measure the degree of heterogeneity in three large preinvasive lesions, all with invasive components to determine the relationship between tumor heterogeneity, spatial distribution, clonal evolution, and invasive progression.

Methods: We identified patients A, B, C with extensive DCIS measuring 7.5 cm, 6 cm, and 7 cm associated with 0.3 cm, 3.8cm, and 3.4 cm of an invasive component and 0, 7 and 1 positive lymph node, respectively. We sequenced the tumor sample for Case A from 32 unique blocks with precise geospatial localization; invasive cancer was identified in 3 of 32 blocks. Case B had 26 blocks sequenced with invasive cancer in 13 of 26 blocks. Case C had 23 blocks sequenced with invasive in 11 of 23 blocks. For germline reference, we sequenced DNA from an uninvolved tissue from each case. NGS libraries were made from FFPE derived DNA (20-40ng) for full exome sequencing. Variant calling was performed by GATK HaplotypeCaller, Platypus and Mutect. Identified somatic mutations were annotated with Oncotator and pathway enrichment analysis was performed with Bioconductor. To investigate the clonal evolution and progression history, phylogenetic trees were constructed in R and sub-clonal analysis was performed with Treeomics.

Results: The sequence data was analyzed with Platypus, MuTect and GATK HaplotypeCaller. The somatic mutation sites were concatenated into one sequence for each sample. Both neighbor-joining trees and maximum parsimony trees were built for each case. Phylogenetic analysis and sub-clonal analysis support the multi-clonal invasion model of invasive cells, in which invasive cancer can evolve from multiple clades, either early or late in the evolutionary history, independently. Dense sampling allowed reconstruction of the temporal order of mutations that accumulated in the cell lineage of the invasive cancers. Furthermore, phylogeny and sub-clone spatial analysis revealed that distant regions may be closely genetically related and showed a weak spatial sub-clone clustering pattern, which is consistent with the predictions of Big Bang model. For driver genes, we find that except for SETD2 in Case B, the majority of driver gene mutations are sub-clonal. Somatic mutations on ATP-binding cassette (ABC) transporter pathway was found in all cases.

Conclusions: Extensive sampling and sequencing of tumors yields important insights about tumor heterogeneity and tumor progression of DCIS to invasive cancer. Variable invasive propensity was identified, with foci of invasion were geospatially associated with preinvasive regions of progressively higher mutational load.

Citation Format: Ding Y, Marks J, King L, Hardman T, Hall A, Mallo D, Rodrigo A, Maley C, Hwang S. Evidence for tumor heterogeneity and clonal evolution during invasive progression in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-07-06.

The relationship between sense of coherence and post-traumatic stress: a meta-analysis

Background: Antonovsky's concept of sense of coherence (SOC) - as a global orientation reflecting an individual's feeling of confidence in both the predictability of their internal and external environment and their ability to cope with stressful and challenging situations in life - shows a negative association with symptoms of post-traumatic stress. However, single studies varying in study characteristics provide heterogeneous effect size estimations. Objective: The purpose of the current study is to investigate the relationship between SOC and post-traumatic stress disorder (PTSD) symptom severity for the first time on a meta-analytical level. Method: The random-effects meta-analysis is based on zero-order correlations (r) and consists of 47 independent samples out of 45 studies (N = 10,883). Results: After correcting for sampling error, the mean correlation between SOC and PTSD symptoms was M(r) = -.41 (excluding four outliers: -.39). However, this effect could not be generalized to all types of PTSD samples owing to substantial remaining heterogeneity. Subsequent moderator analyses investigating the influence of different SOC and PTSD measures, trauma type and duration, mean age and gender imbalances per sample did not reveal significant moderating effects. Conclusions: The meta-analysis reveals a substantial correlation between SOC and PTSD symptom severity: higher SOC levels are associated with lower symptom severity. Thus, future research should progress to the question of whether the relationship between SOC and post-traumatic stress is causal, and by which factors it is moderated. Abbreviations: CD, Cook's distance; DSM, Diagnostic and Statistical Manual of Mental Disorders; (G)RR, general (and specific) resistance resources; IES(-R), Impact of Event Scale (Revised); PDS, Posttraumatic Stress Diagnostic Scale; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTSD, post-traumatic stress disorder; SDR, standard deleted residual; SOC, sense of coherence; SOC-R, Sense of Coherence Scale - Revised.

In inpatient rehabilitation, large amounts of practice can occur safely without direct therapist supervision: an observational study

QUESTIONS

When a hospital gymnasium used for inpatient rehabilitation is set up to allow semi-supervised practice: what percentage of practice is performed as semi-supervised practice, what percentage of patients in the gym are actively engaged in practice at one time, and is the semi-supervised practice that occurs safe?

DESIGN

An observational study using periodic behaviour mapping.

PARTICIPANTS

Patients in general and stroke rehabilitation units of a metropolitan hospital.

OUTCOME MEASURES

Observations in the rehabilitation gym quantified the number of patients in the gym and the numbers of patients practising and resting. In observations of patients practising, the condition of practice was recorded as being with a therapist, with a family member, or with no direct supervision. The number of adverse events during the data collection period was collected from the hospital Incident Information Management System.

RESULTS

The rehabilitation gym was observed on 113 occasions, resulting in 1319 individual patient observations. An average of 12 patients were in the gym during the observations. Practice was being performed with family supervision in 15% of observations and with no direct supervision in 26% of observations, resulting in semi-supervised practice accounting for 41% of all observations of practice. The percentage of observations that were of patients taking part in active practice was 78%. There were no adverse events in the gym.

CONCLUSION

In an inpatient setting, a large percentage of practice can be performed as semi-supervised practice. This does not appear to compromise the time spent in active practice or patient safety.